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NBME 21 Answers

Question#1 (54.0 difficulty score)
A 24-year-old woman with sickle cell disease ...
Serum parvovirus B19 IgM antibody test๐Ÿ”,๐Ÿ“บ

Question#2 (64.0 difficulty score)
A 6-month-old girl is brought to the ...
GM2๐Ÿ”,๐Ÿ“บ

Question#3 (66.9 difficulty score)
An investigator is studying the efficacy of ...
Flagellin๐Ÿ”,๐Ÿ“บ

Question#4 (29.1 difficulty score)
A 67-year-old man comes to the emergency ...
Translation๐Ÿ”,๐Ÿ“บ

Question#5 (53.9 difficulty score)
A 45-year-old woman is brought to the ...
Absorption atelectasis๐Ÿ”,๐Ÿ“บ

Question#6 (66.6 difficulty score)
A normal-appearing 17-year-old girl has never ...
Androgen insensitivity syndrome๐Ÿ”,๐Ÿ“บ

Question#7 (24.8 difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes ๐Ÿ”,๐Ÿ“บ

Question#8 (30.0 difficulty score)
A 52-year-old woman is admitted to the ...
Speak with the two gynecologists to attempt to coordinate care๐Ÿ”,๐Ÿ“บ

Question#9 (16.1 difficulty score)
A 53-year-old woman who underwent an ...
Breast: antagonist; Uterus: partial agonist๐Ÿ”,๐Ÿ“บ

Question#10 (29.9 difficulty score)
A 34-year-old woman is brought to the ...
Primary metabolic acidosis with increased anion gap๐Ÿ”,๐Ÿ“บ

Question#11 (40.5 difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
Schistocytes๐Ÿ”,๐Ÿ“บ

Question#12 (47.0 difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia๐Ÿ”,๐Ÿ“บ

Question#13 (42.5 difficulty score)
A 25-year-old man develops shortness of ...
Decreased alveolar Po2๐Ÿ”,๐Ÿ“บ

Question#14 (21.8 difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae๐Ÿ”,๐Ÿ“บ

Question#15 (48.6 difficulty score)
A 35-year-old man comes to the physician ...
Increased vascular permeability๐Ÿ”,๐Ÿ“บ

Question#16 (64.6 difficulty score)
A 43-year-old man comes to the physician for ...
Aortic๐Ÿ”,๐Ÿ“บ

Question#17 (86.1 difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine๐Ÿ”,๐Ÿ“บ

Question#18 (25.3 difficulty score)
A 61-year-old woman is brought to the ...
Donepezil๐Ÿ”,๐Ÿ“บ

Question#19 (48.3 difficulty score)
A 22-year-old man has had frequent episodes ...
C1 esterase inhibitor (binds activated C1r, C1s)๐Ÿ”,๐Ÿ“บ

Question#20 (31.4 difficulty score)
A 10-year-old girl develops fever, malaise, ...
Retrograde transport through nerves๐Ÿ”,๐Ÿ“บ

Question#21 (27.3 difficulty score)
A 40-year-old man with type 2 diabetes ...
Stimulation of the peroxisome proliferator-activated receptor ฮณ๐Ÿ”,๐Ÿ“บ

Question#22 (40.3 difficulty score)
A 36-year-old man with AIDS elects to ...
Chemokine๐Ÿ”,๐Ÿ“บ

Question#23 (49.6 difficulty score)
A 59-year-old man comes to the physician ...
Foci of keratinization๐Ÿ”,๐Ÿ“บ

Question#24 (63.5 difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change๐Ÿ”,๐Ÿ“บ

Question#25 (49.7 difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm๐Ÿ”,๐Ÿ“บ

Question#26 (39.8 difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis๐Ÿ”,๐Ÿ“บ

Question#27 (29.8 difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption๐Ÿ”,๐Ÿ“บ

Question#28 (68.6 difficulty score)
A 47-year-old man is brought to the emergency ...
Mixed venous oxygen tension๐Ÿ”,๐Ÿ“บ

Question#29 (17.0 difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache๐Ÿ”,๐Ÿ“บ

Question#30 (48.9 difficulty score)
A newborn has female external genitalia and a ...
Dihydrotestosterone๐Ÿ”,๐Ÿ“บ

Question#31 (57.2 difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid๐Ÿ”,๐Ÿ“บ

Question#32 (66.1 difficulty score)
A 50-year-old man has had progressive dyspnea ...
Usual interstitial pneumonitis๐Ÿ”,๐Ÿ“บ

Question#33 (26.1 difficulty score)
A 30-year-old man comes to the physician ...
Varicella-zoster virus infection๐Ÿ”,๐Ÿ“บ

Question#34 (64.1 difficulty score)
A 30-year-old man develops urinary ...
Pelvic nerves๐Ÿ”,๐Ÿ“บ

Question#35 (35.0 difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead๐Ÿ”,๐Ÿ“บ

Question#36 (65.7 difficulty score)
A 51-year-old woman comes to the physician ...
Area labeled 'B' (Parietal cell)๐Ÿ”,๐Ÿ“บ

Question#37 (23.4 difficulty score)
A 35-year-old man with diabetic ketoacidosis ...
Serum potassium concentration๐Ÿ”,๐Ÿ“บ

Question#38 (25.6 difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B๐Ÿ”,๐Ÿ“บ

Question#39 (39.1 difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes๐Ÿ”,๐Ÿ“บ

Question#40 (35.7 difficulty score)
A physician prescribes a recently marketed ...
Phase 4๐Ÿ”,๐Ÿ“บ

Question#41 (33.1 difficulty score)
A 35-year-old woman comes to the physician ...
Uroporphyrinogen decarboxylase๐Ÿ”,๐Ÿ“บ

Question#42 (43.2 difficulty score)
A 36-year-old woman undergoes a total ...
Hyperplasia๐Ÿ”,๐Ÿ“บ

Question#43 (41.5 difficulty score)
A 52-year-old man is brought to the emergency ...
Histamine๐Ÿ”,๐Ÿ“บ

Question#44 (21.1 difficulty score)
A test has been developed to screen for human ...
Predictive value of a positive test๐Ÿ”,๐Ÿ“บ

Question#45 (48.0 difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase๐Ÿ”,๐Ÿ“บ

Question#46 (32.4 difficulty score)
A 66-year-old man is brought to the emergency ...
Lipopolysaccharide stimulation of toll-like receptor๐Ÿ”,๐Ÿ“บ

genetics pedigree
Question#47 (63.5 difficulty score)
A 26-year-old woman (III-2) comes to the ...
50% in females but near 0 in males๐Ÿ”,๐Ÿ“บ

Question#48 (36.5 difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP๐Ÿ”,๐Ÿ“บ

Question#49 (41.8 difficulty score)
An 80-year-old woman comes to the emergency ...
Hydrochlorothiazide๐Ÿ”,๐Ÿ“บ

Question#50 (52.3 difficulty score)
A photograph is shown of a myelin-stained ...
Loss of sensation to vibration over both feet๐Ÿ”,๐Ÿ“บ

Question#1 (18.6 difficulty score)
A 27-year-old man comes to the physician for ...
Schizoid๐Ÿ”,๐Ÿ“บ

Question#2 (45.1 difficulty score)
A 4-year-old girl is conscious but unable to ...
Pseudocholinesterase deficiency๐Ÿ”,๐Ÿ“บ

Question#3 (57.7 difficulty score)
A 17-year-old boy returns to the locker room ...
Apocrine๐Ÿ”,๐Ÿ“บ

Question#4 (33.7 difficulty score)
An 18-year-old woman comes to the office ...
Extensor carpi radialis brevis๐Ÿ”,๐Ÿ“บ

Question#5 (77.6 difficulty score)
A 2-week-old male newborn has a patent ductus ...
Higher than normal left ventricular cardiac output๐Ÿ”,๐Ÿ“บ

Question#6 (61.2 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration๐Ÿ”,๐Ÿ“บ

Question#7 (33.7 difficulty score)
A 50-year-old man with rheumatoid arthritis ...
Anemia of chronic disease๐Ÿ”,๐Ÿ“บ

Question#8 (59.4 difficulty score)
A 55-year-old man is diagnosed with renal ...
Cortex๐Ÿ”,๐Ÿ“บ

Question#9 (31.3 difficulty score)
A 40-year-old man is brought to the emergency ...
Metabolic acidosis and respiratory acidosis๐Ÿ”,๐Ÿ“บ

Question#10 (33.9 difficulty score)
A 42-year-old woman comes to the physician ...
Rosacea๐Ÿ”,๐Ÿ“บ

Question#11 (39.6 difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac๐Ÿ”,๐Ÿ“บ

Question#12 (76.8 difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis๐Ÿ”,๐Ÿ“บ

Question#13 (45.3 difficulty score)
A 53-year-old woman with gastroesophageal ...
Omeprazole๐Ÿ”,๐Ÿ“บ

Question#14 (87.0 difficulty score)
A 30-year-old woman comes to the office ...
Abnormal brain development๐Ÿ”,๐Ÿ“บ

Question#15 (66.4 difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal๐Ÿ”,๐Ÿ“บ

Question#16 (59.4 difficulty score)
A 34-year-old woman comes to the physician ...
Atrioventricular bundle๐Ÿ”,๐Ÿ“บ

Question#17 (32.1 difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair๐Ÿ”,๐Ÿ“บ


Question#19 (48.7 difficulty score)
A 3-year-old boy who recently immigrated to ...
Increased proportions of osteoid๐Ÿ”,๐Ÿ“บ

Question#20 (53.0 difficulty score)
A 14-year-old girl is brought to the ...
Trichotillomania๐Ÿ”,๐Ÿ“บ

Question#21 (58.6 difficulty score)
A 35-year-old woman undergoes flexible ...
Superior to the superior concha๐Ÿ”,๐Ÿ“บ

Question#22 (39.7 difficulty score)
A 33-year-old woman, gravida 4, para 4, is ...
Transfusion-related acute lung injury๐Ÿ”,๐Ÿ“บ

Question#23 (35.3 difficulty score)
A 4-year-old boy with chronic granulomatous ...
Macrophages producing interleukin-1 (IL-1)๐Ÿ”,๐Ÿ“บ

Question#24 (67.5 difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma๐Ÿ”,๐Ÿ“บ

Question#25 (23.0 difficulty score)
A 54-year-old man comes to the physician for ...
Area labeled 'F' (Efferent arteriole)๐Ÿ”,๐Ÿ“บ

Question#26 (47.9 difficulty score)
A healthy 32-year-old woman at 35 weeks' ...
Birth canal reflex๐Ÿ”,๐Ÿ“บ

Question#27 (16.1 difficulty score)
A 47-year-old woman with psoriasis comes to ...
โ€œMost people find it difficult to stick to a routine. How did you do?โ€๐Ÿ”,๐Ÿ“บ

Question#28 (17.6 difficulty score)
A 64-year-old woman with type 2 diabetes ...
Gemfibrozil๐Ÿ”,๐Ÿ“บ

Question#29 (69.5 difficulty score)
A healthy 25-year-old man is participating in ...
Alanine๐Ÿ”,๐Ÿ“บ


Question#31 (59.2 difficulty score)
A 37-year-old man is brought to the emergency ...
Intercostal๐Ÿ”,๐Ÿ“บ

Question#32 (25.2 difficulty score)
A 17-year-old boy has the acute onset of ...
Lymphocytes๐Ÿ”,๐Ÿ“บ

Question#33 (64.0 difficulty score)
A 68-year-old man comes to the physician ...
Libido: normal; Nocturnal erections: normal๐Ÿ”,๐Ÿ“บ

Question#34 (54.3 difficulty score)
A 28-year-old man is brought to the emergency ...
Inferior rectus and inferior oblique๐Ÿ”,๐Ÿ“บ

Question#35 (73.9 difficulty score)
A 4-month-old female infant is brought to the ...
Hyponatremia๐Ÿ”,๐Ÿ“บ

Question#36 (18.8 difficulty score)
An investigator is conducting a study of ...
Enfuvirtide๐Ÿ”,๐Ÿ“บ

Question#37 (31.1 difficulty score)
A 17-year-old boy is evaluated for ...
Craniopharyngioma๐Ÿ”,๐Ÿ“บ

Question#38 (16.2 difficulty score)
A 63-year-old man with bladder cancer starts ...
Tubulin polymerization stabilization๐Ÿ”,๐Ÿ“บ

Question#39 (52.5 difficulty score)
A 64-year-old man with bronchospastic ...
Enhanced action of the agonist at ฮฒ-adrenergic receptors๐Ÿ”,๐Ÿ“บ

Question#40 (35.3 difficulty score)
Acetaminophen and nonsteroidal ...
Prostaglandin E2๐Ÿ”,๐Ÿ“บ

Question#41 (34.6 difficulty score)
A 75-year-old woman has the sudden onset of ...
Posterior inferior cerebellar๐Ÿ”,๐Ÿ“บ

Question#42 (21.4 difficulty score)
A 26-year-old man with HIV infection comes to ...
Penicillin๐Ÿ”,๐Ÿ“บ

Question#43 (39.4 difficulty score)
A 78-year-old woman is brought to the ...
Embolectomy๐Ÿ”,๐Ÿ“บ

Question#44 (28.6 difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left๐Ÿ”,๐Ÿ“บ

Question#45 (36.8 difficulty score)
A 3-year-old boy is brought to the emergency ...
Synthesis of factor X (Stuart factor)๐Ÿ”,๐Ÿ“บ

Question#46 (39.7 difficulty score)
An 8-year-old girl is brought to the ...
โ€œYour daughterโ€™s development is normal.โ€๐Ÿ”,๐Ÿ“บ

Question#47 (46.8 difficulty score)
A 55-year-old woman comes to the physician ...
Increased parathyroid hormone๐Ÿ”,๐Ÿ“บ

Question#48 (41.7 difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis๐Ÿ”,๐Ÿ“บ

Question#49 (27.4 difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus๐Ÿ”,๐Ÿ“บ

Question#50 (56.0 difficulty score)
A 65-year-old woman comes to the emergency ...
Lung and common carotid artery๐Ÿ”,๐Ÿ“บ

Question#1 (17.5 difficulty score)
A 30-year-old woman develops dimness of vision
Ethambutol๐Ÿ”,๐Ÿ“บ

Question#2 (39.4 difficulty score)
A 40-year-old man with interstitial pulmonary ...
Increased radial traction on airways๐Ÿ”,๐Ÿ“บ

Question#3 (16.7 difficulty score)
A 55-year-old African American man with ...
Tell the patient that he can change his mind about participating๐Ÿ”,๐Ÿ“บ

Question#4 (49.1 difficulty score)
A clinical trial is conducted to compare the ...
Surgical procedure group: 400; Medical management group: 400๐Ÿ”,๐Ÿ“บ

Question#5 (50.1 difficulty score)
A 70-year-old woman is found to have ...
Candida albicans ๐Ÿ”,๐Ÿ“บ

Question#6 (40.6 difficulty score)
A 40-year-old African American woman comes to ...
1,25-Dihydroxycholecalciferol๐Ÿ”,๐Ÿ“บ

Question#7 (55.3 difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation๐Ÿ”,๐Ÿ“บ

Question#8 (49.3 difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies๐Ÿ”,๐Ÿ“บ

Question#9 (38.6 difficulty score)
A 75-year-old woman is brought to the ...
Shrunken eosinophilic (red) neurons๐Ÿ”,๐Ÿ“บ

Question#10 (24.3 difficulty score)
A 30-year-old man has had intermittent severe ...
Cysteine๐Ÿ”,๐Ÿ“บ

Question#11 (72.0 difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia๐Ÿ”,๐Ÿ“บ

Question#12 (46.1 difficulty score)
A 55-year-old man with hypertension comes to ...
Left renal artery atherosclerosis๐Ÿ”,๐Ÿ“บ

Question#13 (38.8 difficulty score)
A 40-year-old woman comes to the physician ...
Antagonizes VLDL-cholesterol secretion๐Ÿ”,๐Ÿ“บ

Question#14 (20.8 difficulty score)
A 35-year-old man is brought to the emergency ...
Activation of adenylyl cyclase๐Ÿ”,๐Ÿ“บ

bilirubin
Question#15 (48.2 difficulty score)
A 47-year-old man has jaundice. Laboratory ...
Obstruction of the bile duct๐Ÿ”,๐Ÿ“บ

Question#16 (66.4 difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma๐Ÿ”,๐Ÿ“บ

Question#17 (43.4 difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric๐Ÿ”,๐Ÿ“บ

Question#18 (37.0 difficulty score)
An 83-year-old man comes to the physician ...
Bullous pemphigoid antigen๐Ÿ”,๐Ÿ“บ

Question#19 (47.3 difficulty score)
A 25-year-old woman develops increasing ...
Four-chamber dilation๐Ÿ”,๐Ÿ“บ

Question#20 (56.7 difficulty score)
A 68-year-old woman has had a fever and ...
Reactive granulocytosis๐Ÿ”,๐Ÿ“บ

Question#21 (53.5 difficulty score)
A screening program is instituted for ...
10%๐Ÿ”,๐Ÿ“บ

Question#22 (40.0 difficulty score)
A 9-year-old boy has mild mental retardation ...
Rhabdomyoma๐Ÿ”,๐Ÿ“บ

Question#23 (41.5 difficulty score)
A 43-year-old woman dies after a 10-year ...
Area labeled โ€˜Cโ€™ (Caudate nucleus)๐Ÿ”,๐Ÿ“บ

Question#24 (55.3 difficulty score)
Diastolic blood pressures are obtained in two ...
Median of group Y: higher; Mode of group Y: higher๐Ÿ”,๐Ÿ“บ

Question#25 (49.2 difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi๐Ÿ”,๐Ÿ“บ

Question#26 (47.4 difficulty score)
A 19-year-old woman comes to the office ...
Descending colon๐Ÿ”,๐Ÿ“บ

Question#27 (42.6 difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid๐Ÿ”,๐Ÿ“บ

Question#28 (77.2 difficulty score)
A 1-year-old girl is admitted to the hospital ...
Disruption of the secondary structure of collagen molecules๐Ÿ”,๐Ÿ“บ


Question#30 (49.7 difficulty score)
A 41-year-old man comes to the physician ...
Abduction of the upper extremity๐Ÿ”,๐Ÿ“บ

Question#31 (53.1 difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4๐Ÿ”,๐Ÿ“บ

Question#32 (25.9 difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin๐Ÿ”,๐Ÿ“บ

Question#33 (63.1 difficulty score)
Left radial arterial and venous blood samples ...
HCO3โˆ’ transported in the plasma๐Ÿ”,๐Ÿ“บ

Question#34 (42.9 difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Membranous glomerulonephritis๐Ÿ”,๐Ÿ“บ

Question#35 (62.3 difficulty score)
A 63-year-old woman comes to the physician ...
Increased resting cardiac output๐Ÿ”,๐Ÿ“บ

Question#36 (73.0 difficulty score)
Which of the following best explains why the ...
Myeloma cells do not have membrane-bound surface immunoglobulin๐Ÿ”,๐Ÿ“บ

Question#37 (71.6 difficulty score)
A 5-year-old boy who has homocystinuria ...
The line on the graph labeled โ€˜Bโ€™๐Ÿ”,๐Ÿ“บ

Question#38 (38.0 difficulty score)
A 28-year-old man develops a temperature of ...
Granulocyte colony-stimulating factor๐Ÿ”,๐Ÿ“บ

Question#39 (29.5 difficulty score)
A 74-year-old woman with mild dementia is ...
Inability to understand the severity and prognosis of her medical condition๐Ÿ”,๐Ÿ“บ

Question#40 (41.4 difficulty score)
A 65-year-old woman undergoes surgical repair ...
Area labeled โ€˜Aโ€™ (Cranial nerve 3)๐Ÿ”,๐Ÿ“บ

Question#41 (39.3 difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder๐Ÿ”,๐Ÿ“บ

Question#42 (37.3 difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia๐Ÿ”,๐Ÿ“บ

Question#43 (22.8 difficulty score)
An undernourished 70-year-old man has fever, ...
Interferon-ฮณ๐Ÿ”,๐Ÿ“บ

Question#44 (44.8 difficulty score)
A 23-year-old woman develops persistent ...
Stabilization of mast cell membranes๐Ÿ”,๐Ÿ“บ

Question#45 (66.8 difficulty score)
A 28-year-old man comes to the physician for ...
Fructose๐Ÿ”,๐Ÿ“บ

Question#46 (18.7 difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale๐Ÿ”,๐Ÿ“บ

Question#47 (28.3 difficulty score)
A 48-year-old man comes to the physician ...
Increased intestinal iron absorption๐Ÿ”,๐Ÿ“บ

Question#48 (32.2 difficulty score)
A 29-year-old woman comes to the physician ...
Baclofen๐Ÿ”,๐Ÿ“บ

cell_bio cell_transport cell_trafficking
Question#49 (57.8 difficulty score)
The gene that codes for a protein normally ...
Deletion of a hydrophobic amino acid sequence from the N terminus๐Ÿ”,๐Ÿ“บ

Question#50 (63.5 difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector๐Ÿ”,๐Ÿ“บ

Question#1 (50.1 difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix๐Ÿ”,๐Ÿ“บ

Question#2 (48.3 difficulty score)
A 23-year-old woman comes to the student ...
Obliterative endarteritis with lymphocytes and plasma cells๐Ÿ”,๐Ÿ“บ

Question#3 (26.0 difficulty score)
A study was performed that evaluated the ...
Odds ratio๐Ÿ”,๐Ÿ“บ


Question#5 (56.5 difficulty score)
An 11-year-old boy has had persistent pain in ...
Lung๐Ÿ”,๐Ÿ“บ

Question#6 (42.5 difficulty score)
A 55-year-old man comes to the physician ...
Cortisol๐Ÿ”,๐Ÿ“บ

Question#7 (48.2 difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue๐Ÿ”,๐Ÿ“บ

FA_missing
Question#8 (52.4 difficulty score)
A 70-year-old woman has had recurrent ...
Euthyroid sick syndrome๐Ÿ”,๐Ÿ“บ

porphyria phototherapy
Question#9 (41.8 difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda๐Ÿ”,๐Ÿ“บ

renal SIADH hyponatremia
Question#10 (49.6 difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia๐Ÿ”,๐Ÿ“บ


Question#12 (39.8 difficulty score)
A 24-year-old man with a history of drug ...
Heroin๐Ÿ”,๐Ÿ“บ

Question#13 (56.6 difficulty score)
A 4-month-old boy is diagnosed with a rare ...
Dilated rough endoplasmic reticulum๐Ÿ”,๐Ÿ“บ

Question#14 (57.6 difficulty score)
A 25-year-old woman has a 3-week history of ...
Autoantibodies against platelet glycoproteins๐Ÿ”,๐Ÿ“บ

Question#15 (62.0 difficulty score)
A 5-year-old boy is brought to the physician ...
Lack of choroidal pigment deposition in the macula๐Ÿ”,๐Ÿ“บ

Question#16 (22.4 difficulty score)
A 40-year-old woman who had pneumonia due to ...
Surfactant๐Ÿ”,๐Ÿ“บ

Question#17 (33.5 difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width๐Ÿ”,๐Ÿ“บ

Question#18 (13.3 difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis๐Ÿ”,๐Ÿ“บ

Question#19 (37.8 difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla๐Ÿ”,๐Ÿ“บ

Question#20 (61.7 difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY๐Ÿ”,๐Ÿ“บ

Question#21 (12.6 difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization๐Ÿ”,๐Ÿ“บ

Question#22 (49.0 difficulty score)
A 57-year-old woman is brought to the ...
Ninth๐Ÿ”,๐Ÿ“บ

Saline Lymphatic
Question#23 (64.7 difficulty score)
An investigator is studying the regulation of ...
Intravenous infusion of 0.9% saline for 5 minutes๐Ÿ”,๐Ÿ“บ

Question#24 (38.3 difficulty score)
A 56-year-old man undergoes a renal ...
IgG plus complement๐Ÿ”,๐Ÿ“บ

Question#25 (70.1 difficulty score)
An 80-year-old woman cannot concentrate her ...
2.0๐Ÿ”,๐Ÿ“บ

Question#26 (27.3 difficulty score)
The immunosuppressive agent cyclosporin A ...
Interleukin-2 (IL-2) gene transcription๐Ÿ”,๐Ÿ“บ


Question#28 (31.1 difficulty score)
A 56-year-old man undergoes surgical ...
Release of cholecystokinin๐Ÿ”,๐Ÿ“บ

Question#29 (35.2 difficulty score)
A 22-year-old man comes to the physician ...
Formation of destructive free radicals๐Ÿ”,๐Ÿ“บ

Question#30 (38.7 difficulty score)
A 5-year-old boy is admitted to the hospital ...
ApoC-II๐Ÿ”,๐Ÿ“บ

Question#31 (36.9 difficulty score)
A 48-year-old woman comes to the physician ...
Paracrine stimulation of osteoclasts by osteoblasts๐Ÿ”,๐Ÿ“บ

Question#32 (16.2 difficulty score)
A 19-year-old college student says he hears ...
Risperidone๐Ÿ”,๐Ÿ“บ

Question#33 (54.5 difficulty score)
A female newborn delivered at 26 weeks' ...
Retina๐Ÿ”,๐Ÿ“บ

Question#34 (52.1 difficulty score)
A healthy 8-year-old boy is brought to the ...
Stimulation of the release of biogenic amine neurotransmitters๐Ÿ”,๐Ÿ“บ

Question#35 (27.5 difficulty score)
A 50-year-old woman is admitted to the ...
Didanosine (ddI)๐Ÿ”,๐Ÿ“บ

Question#36 (61.1 difficulty score)
A 45-year-old man comes to the physician ...
Chondrosarcoma๐Ÿ”,๐Ÿ“บ

Question#37 (50.5 difficulty score)
A 66-year-old right-handed woman develops the ...
Area labeled 'B' (Internal capsule)๐Ÿ”,๐Ÿ“บ

Question#38 (34.3 difficulty score)
A 62-year-old woman is brought to the ...
Instruct the patient to keep notes and lists to help her memory๐Ÿ”,๐Ÿ“บ

Question#39 (52.1 difficulty score)
A 46-year-old man comes to the physician ...
1/15๐Ÿ”,๐Ÿ“บ

Question#40 (54.6 difficulty score)
A study is conducted to assess the normal ...
500 Men from a list of patients scheduled to be examined by a urologist๐Ÿ”,๐Ÿ“บ

Question#41 (17.3 difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide๐Ÿ”,๐Ÿ“บ

Question#42 (22.4 difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...
Multifactorial๐Ÿ”,๐Ÿ“บ

Question#43 (26.4 difficulty score)
A 4-year-old boy falls and lacerates his ...
Formation of fibrin clot๐Ÿ”,๐Ÿ“บ

renal diuretics GFR
Question#44 (41.7 difficulty score)
A 28-year-old woman with chronic renal ...
Furosemide๐Ÿ”,๐Ÿ“บ

neuro pharm magnesium
Question#45 (70.2 difficulty score)
During an experiment, an investigator ...
NMDA receptors are blocked by Mg2+ at the resting membrane potential๐Ÿ”,๐Ÿ“บ

process_of_elimination Li_Fraumeni p53
Question#46 (49.0 difficulty score)
A 14-year-old girl is brought to the ...
TP53 ๐Ÿ”,๐Ÿ“บ

Question#47 (25.2 difficulty score)
While lifting weights, a 24-year-old man ...
Strangulation๐Ÿ”,๐Ÿ“บ


Question#49 (44.2 difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus๐Ÿ”,๐Ÿ“บ

Question#50 (21.5 difficulty score)
A 19-year-old woman is brought to the ...
Scaphoid๐Ÿ”,๐Ÿ“บ

Recent comments ...

... nosancuck made a comment on nbme21/block1/q#5 (A 45-year-old woman is brought to the emergency...)
 +72 
submitted by nosancuck(90)
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rBuh lte em eltl oyu a lil srteec

PPEE nptsvere eAsattiscle KAA tda NGUL LPCSEAOL

otnD be inwryor batou mndora wrosd teyh tpus ni rfton of eht GHHI EILYD nose

hungrybox  literally LOL'd lmao I love this +14
... assoplasty made a comment on nbme21/block3/q#31 (A 28-year-old woman at 18 weeks' gestation has...)
 +70 
submitted by assoplasty(98)
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I tinkh hte oeccnpt erthโ€™ye ientgst is het ecdaneisr TGB leselv in cegpryann, nad ton sjtu yheiytrsdiphorm in rng.aele

hWne nrecesing orf myhyd,tri/iypshohrepo SHT selevl rea AWSAYL trfeeilpylnear ececdhk ebsuace htey rae mroe nvsseeiit ot tinmeu firceeedsfn in 3/TT.4 fetnO mteis TSH ellsve cna mttdeaseorn a egncha enve hnew 43T/T evlels era in het luincalcbsi ne.rga hTe nyol encxotpie to htis wudol be in genncrpay (adn I ugess eybma irevl rliaeuf? I buotd yeht lduwo ksa ihst h.uhg)ot iHgh songreet ellesv resepnvt hte ivrle ofrm bgnrkiae dwno T,BG glanedi to rieadesnc GBT elevsl in het .muesr hTsi ndsib ot free 4T, caredegnis the ntaoum fo ilaalaveb eref 4T. sA a omectynporas imec,asmnh THS eslevl rae esynlratitn iderncaes nad the ERTA of 4T ictpunoord si ecaenisdr to liephrnes snbaelie feer 4T vs.eell roevwHe eht ALTOT nmutao of T4 is erdae.snci

The quoitesn is ngiaks who to ofmnric peshrrdyiyotimh ni a engtpnra noamw ;g-&-t you ende to ekchc EERF 4T eevlsl c(eabues ethy dhulso eb lonram edu to ntoasepromyc resnpe.)so uYo taocnn ccehk TSH ualuyl(s daeteelv ni paeyrcgnn ot soacmtnpee rof daeesinrc )B,GT dan uoy ntaocn kcceh ltoat 4T sleevl lliw( be sdcei)enar. uoY tog het narwse hitrg rhetie ywa utb I ntikh sthi si a tiefrdfen rogiesnna owtrh n,oicndsrgei beauces ehyt can kas ihts cnotepc ni oehtr oscetnxt fo enms-o,repystheirg dan fi ehyt ldiste โ€œHTโ€S sa na nweras hceoic htat wuold eb rtcircoen.

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +9
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +3
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +1
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +2
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +2
lovebug  Amazing answer! THX +1
an_improved_me  Just to add: Pregnancy is not an exception to using TSH in suspected hyperthyroid pregnant patients (not sure in hypothyroid); you would still get a TSH first, and if its unusually low, you would then proceed to measure T4 (free, total), and so on. https://www.uptodate.com/contents/hyperthyroidism-during-pregnancy-clinical-manifestations-diagnosis-and-causes?search=hyperthyroidism%20in%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H994499 +1
... lnsetick made a comment on nbme21/block2/q#3 (A 17-year-old boy returns to the locker room after...)
 +54 
submitted by lnsetick(97)
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  • ieAncPor = yruo irmapst mlles leki an AEP
  • UceeRMn = rteโ€™hes no OOMR ni uroy srae csein eryeโ€™th ullf fo axw
  • enEC-CYR = wenh ouy ieEces,Cr ouyr poser rea gYRnCi
  • ucBaoesSE = mSBuE is EPSgEin uto of oury osrep
hungrybox  as an ape i'm offended +34
dr.xx  stop being an ape. evolutionize! +7
dbg  as a creationist i'm offended +11
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +3
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +2
... seagull made a comment on nbme21/block1/q#2 (A 6-month-old girl is brought to the physician...)
 +51 
submitted by seagull(1677)
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! I ateh htese whti a inrnugb Fn**gi* nai.psos mshTbu pu fi yuo raeeg

mcl  Amen brother +1
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +33
mcl  oh my god are you me +1
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +6
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +4
abhishek021196  What is HSM? +
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +1
djeffs1  @lakshmi Link? +
... drdoom made a comment on nbme21/block3/q#49 (The gene that codes for a protein normally found in...)
 +51 
submitted by drdoom(957)
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Teh entsshsiy fo ullatvriy lal rsiopetn tte()Agdpm-eN;R&ip succro in hte .ypmltaocs[1] shaโ€™Tt eehrw lla rsseomobi erdei,s tafer la.l bisRmose,o chhiw are ymtslo tsju NARr (~3/2 NrAR + 1/3 rt*epni,o by ,igt)whe are bsmadlees ni eht suuenlc utb lnyo od htier sfftu neco hyet get ot eht yamocl.pts

roF a pnoiter to avele tis ligraoni nhwtoemo fo teh ocltsoy nad ecemob a intsdeer of teh celusnu r,o sy,yyyyya teh ondmiascepl cuulemt,ri ti edesn to heva a ltltei stgrin of amion adsci which stuoh โ€œI genolb ni het ucneโ€ul!s ro Iโ€œ bgenol ni eht oliapmecsnd ltuc!โ€iurme

stiroPen aetluyltim senddtie fro eht RE tcaionn an laaiyingivtenum nadem ritsgn fo oimna dsaic kwonn sa inโ€œsgal โ€eeqcenus, c,whih rof eth opsserpu of hte Sept 1, is yaaslw ta eht r-smt.Nueni heT naigsl euqcenes etlsl oetrh tooccliys istrop,ne !yโ€œHe eTka me n(da the tesr fo teh ippedte of hhiwc I am )artp ot teh Rโ€E!

nI eth esenbac of tshi laings, a enoprit illw remani ni sti dueโ€œtlโ€af ohem fo eht colstoy.

su&ersoHeqr; a cnei ctcheimas snwhiog the lowf fo iesnotrp omrf iitlian sehinssyt ot alfni tnans:ieostid


senntEdo

  1. eโ€œTh nseshtisy fo ylrvuatli lla niopetrs ni the ellc sibnge on rsoobiems in hte lyo.toโ€cs (lsEnaseit lCel yiogBol, blertsA et al,. 2,140 .p 29)4

f*I uoy layrel nwat yuro ndim ln,obw scdnroei htta even het ripnteo bstnsuiu atth maek up atht 3/1 fo a ebisrmoo aer tsmehlvees yiltialni enysizteshd in eth o;olstcy ,elart heyt rae soprndartet cbka tnio hte necusul iav eth rcluean re.op

qball  Awesome explanation. Now explain it to me like I'm 5. +8
drdoom  All baby peptides are born in the cytosol. But some baby peptides have a birthmark at their N-terminus. The birthmark tells a special mailman that this baby needs to be delivered somewhere else. If you chop off the birthmark โ€” or erase it somehow โ€” the mailman never knows to take baby to its true home. The end. Now go to sleep or Santa wonโ€™t bring your presents. +47
... niboonsh made a comment on nbme21/block4/q#45 (During an experiment, an investigator observes that...)
 +50 
submitted by niboonsh(367)
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Qsc4.ucz-p/2tww=uoo?:au.tohve/w/HyDmwbhvwtt fi ru zayl keil ,em tshi is a dogo srereehfr oivde

d_holles  Amazing video dude. Somehow never learned this in neuro lol. +6
aag  Awesome video! Is this why you can give Mg2+ to eclampsia patients, because if so, mind goddamn blown. +2
... hayayah made a comment on nbme21/block3/q#33 (Left radial arterial and venous blood samples are...)
 +41 
submitted by hayayah(1100)
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eht ymatrijo fo bocnra eiiodxd lsumoecel era idacrre sa aptr of het bnrbaocetia uefrbf et.yssm In hits etss,ym bacron iieodxd sfeudfsi iotn the sBRC. baoicnrC eayrdhsan CA() iwithn CRsB lckiyuq eorntscv eth narbco ieoiddx tion crcaniob cida C2O(H3). branioCc acdi si an eusnatbl aemeerdtniti uleemloc htta eimmaedyitl ciidsstseoa oitn ocreianatbb sion 3-)(OCH nda nohredgy )H(+ os.ni

hTe lewyn nezsistdehy crbbitnaoea ion is nerdapsttor uto fo teh RBC ntoi het aplmas ni naxgehec rof a chdolrei noi (โˆ’)C;l sthi si cedall hte eohricdl tfi.hs nWeh eht bodlo ershace hte sgu,nl eth ainaebcbrto oni si arortnsdpte kacb oint het CBR in xeecanhg ofr eth edihcolr oni. ehT +H oin aisesisoctd omfr eht hnimbologe dan dsnib to hte oibaerntacb nio. Tish ersucopd teh inccboar iadc tinedritm,aee hihwc si creoednvt bcak tino rabnco dixoeid ogutrhh eth nzyiecatm aicotn fo AC. Teh obacnr dexiiod ueporddc is leepelxd urohthg teh nugls gdruin nleaxatio.h

hungrybox  Amazing explanation. Thank you!! +2
namira  in case anyone wants to visualize things... https://o.quizlet.com/V6hf-2fgWeaWYu1u23fryQ.png +5
ergogenic22  CO2 is carried in the blood is bound to hemoglobin, known as carbaminohemoglobin (HbCO2) (5%), dissolved CO2 (5%), bicarb is 90% +3
pg32  Nice explanation, but can anyone clarify how we know from the question that we are measuring HCO3 rather than dissolved CO2? +3
qball  @pg32 This question is asking about what accounts for the LARGER amount of co2 and the HCO3 buffer is about 85% of this transport and dissolved C02 is about 5-7%. https://courses.lumenlearning.com/wm-biology2/chapter/transport-of-carbon-dioxide-in-the-blood/ +3
teepot123  fa 19 pg 656 +1
surfergirl  "majority of blood CO2 is carried as HCO3- in the plasma." I guess that is all they're testing us on, just in a very convoluted way. +
... mcl made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
 +36 
submitted by mcl(618)
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Lleabde RXC iswognh opiiston fo eerffintd vsae.vl

hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
hyperfukus  this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +
mannywillsee  So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +2
... notadoctor made a comment on nbme21/block1/q#32 (A 50-year-old man has had progressive dyspnea on...)
 +32 
submitted by notadoctor(165)
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lasuU restitntilai tesinnupiom is teh clolghaoitsi dfoiinniet fo otiiIahdcp mpnrlyuao is.fsirbo We nwok ahtt hits ttpinae sha raloympun frsiibos csabeeu eht isutoqne ssetta ahtt teehr si uibfrso cngtknehii fo eth vrloelaa setp.a hisT utsenqoi saw utjs sgnetti atht we nwke eht ehort emnas for ylaonuPrm orsFbisi.

aneurysmclip  Nbme back at it again +28
pg32  Is it still considered idiopathic pulmonary fibrosis is it appears to have been caused by an atypical pneumonia? +1
zevvyt  Why not Sarcoidosis? Wouldn't Sarcodosis also be a chronic inflamation with fibrous thickening? +2
swagcabana  UIP is a better answer. Sarcoid is a leap in logic, usual interstitial pneumonitis is textbook histological definition of idiopathic pulmonary fibrosis. The biopsy has no mention of noncaseating granulomas and the clinical picture is not consistent with an inflammatory process. You have to focus on the better answers, try not to get caught up in the "why nots?" Calling this sarcoidosis is like someone coming in with prototypical asthma and jumping to eosinophilic granulomatous with polyangiitis. Sure its a possibility but its definitely not likely. +6
mangotango  I picked โ€œdiffuse alveolar damageโ€ with Pulmonary Fibrosis in mind but these are actually key words for ARDS :/ +3
zevvyt  thank you swagcabana! Very good explanation and strategy! +
... hungrybox made a comment on nbme21/block3/q#15 (A 47-year-old man has jaundice. Laboratory findings...)
 +32 
submitted by hungrybox(1108)
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wyh hsesomlyi si rwong:

Teehr sduhlo oamslt eevrn eb rgtatihs pu nibibulir ni eth u.irne In esyimoslh, the sexcse biibnuril is rcxtdeee in hte b.iel tArfe craabielt vocsnirone dna rtuaeke,p omse will eb rxtedece ni het nurei as rlu.binio oHevw,re in obtsrituvce sros,ddeir teh cojagtnude bbiiiunrl iwll revne vhae hte pirtnoutypo ot enugdor leacratbi rocennvsio ot br/o.elsiocirntu In tish yw,a teh udjenctaog niiburibl ahs on retoh ywa to eb rcdtexee hrote ntah idrteylc ni eth uer.in

tirceds to cnrua/637aal/ no idrdte

skip_lesions  Found a good pic showing bilirubin metabolism +
... hungrybox made a comment on nbme21/block2/q#17 (Scientists have identified the flawed gene that...)
 +30 
submitted by hungrybox(1108)
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hwne ffdi enligs artnsd rarepi shiacmmnse rea usd:e

  • aeirrp wnyel detenyhssiz a:ndsrt imamstch eriarp chn(yL )ymonsedr
  • irprea nimdpiyrei rdseim dsueac yb tda VU eepoxu:sr oeutlinedc cxeiniso iraper (radrXomee u)memnopitgs
  • arpier ateoxio/uotnsncsp taaitln:roe sbae xeoiisnc paerir
meningitis  Brca: recombinant repair +
brotherimodu  P.40 FA2019 lists the different DNA repair mechanisms +2
teepot123  fa '19 pg 382/3 +
... jambo2222 made a comment on nbme21/block4/q#5 (An 11-year-old boy has had persistent pain in his...)
 +30 
submitted by jambo2222(30)
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tIsโ€™ na sstoaoamceor. araScom = oaeogesmthun .tmes โ€™tsI ni teh esgl so tihnk who a DTV egos ot u.ngl ameS daie.

tinydoc  Perfect way to remember it. Thank you! +10
chandlerbas  Iused the mnemonic PB (lead) KeTtLe....looking at the stem it said "osteolytic mass" meaning that it has to be either Breast, Kidney, thyroid or lungs. none of the rest are options leaving lungs. but jambo2222 very noiice that works too! +1
jajajaja  @chandlerbas I think you might be using the mneumonic backwards- PB-KTL is for primary cancers that met to bone. For example, a primary lung cancer can met to bone and cause an osteolytic lesion. But in this case the primary cancer is the osteosarcoma. Meaning that the mneumonic doesn't actually apply to this question +14
chandlerbas  ya you're right good stuff!! I dont know why that made sense during the question...anyways to add to the other comments...osteosarcomas are aggressive and 10% metastasize to the lungs via hematogenously at the time of diagnosis. +
mtkilimanjaro  just to add, in terms of venous circulation everything goes to heart via vena cava and then to the lungs. The only way the bone would metastasize to these other structures would be if it continued through arterial circulation without seeding, which seems unlikely. The only ones that spread to the liver are from the PORTAL venous system, aka not bone only colon etc. +1
... madojo made a comment on nbme21/block1/q#39 (A 33-year-old woman comes to the physician because...)
 +28 
submitted by madojo(181)
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woKn ruyo 'TDSs abby )-; gg(oin ohtgurh eyvre rothe ceicho on thsi sunoet):iq

  • lcaateirB asgnosiiv ceasdu yb ldgrneelaar ivsgallnia. Se a nth,i fof ewhti carghides nad yihfs lmsel (shfi in the )er.adng eehsrT' no mnltiinoaafm Lab sg:inndif pH rgterae tahn 45. us(tj ikle snmicri)asio,oht adn a vspiiote iwffh tste hwit KHO. meSt lilw yas mtoeshing tauob musdoloaor rhiacsgde nda swho teh nmouasif CULE LLCSE fi ew rae kyuc.l oNt eth newasr fro htsi tniueoqs oyilvusbo bsucaee we odwlu not epxcte secslive wthi isth aetricbla a.sdiees

  • ianssdiCiad si ognig to be yoru hcitk agetcto echese hrsgaceid, hitw .imnaimaoftln mnrlao Hp ees u.pophsehydea tTrea hwti tpicloa ttsi,nyan ro arol ozunacolfle uesnls r'oeuy patenngr anht eus roleaitmlzC.o aAgin otn ggnoi to ees nya i.seclves

  • ordicnahC rpe rwdlou is atcasiodes hwti ipelmasHouh dureciy uyo lwil heva a epDe prutenul ipnaluf luecr wiht paevstuirpu spylihinedtam. liWl be ltod taht atienpt sha alupfni laniungi ,seodn eehtr mya eb utlmeipl depe lcrseu wtih ylal-wogrey u.eeadtx You od ryc htiw .H iuRdYC hTsi nduotw'l be tuer orf awth uro itnapet hsa ni sthi eitosnqu bceeasu we 'arten lodt fo yna niagulni taoepy.hdna a iknl ot a rcadocnih VDA

  • idalyamCh tcatsoiamhr ecssua lplouomnhyrgmaa meruenev hcwih si lasml llsoawh crle,us lpaisn,es tbu ehtn eth lgrea ulanpfi asdecleoc nnagliiu hlmpy ednso kaa SE.OBUB epdraomC iwht gneanoorh hte sderaichg si ermo rnetnhi dan ty.wrea nigAa tno eht easc heer sa ist fanluip adn no nntoime of nya .BSEOBOUS heT diaerhcsg in oangerhor si ermo ct.khier hotB aled ot ID,P ttrea rof both esucbae nictcenfoo is onmo.mc htWi hotb paetitn aym eahv oems sort of npia ro griunnb tneoasnsi uopn u.nniratoi reliSte ypuari hhugto for tbo.h

  • doClyamon ucnimuacmat si a aottifnnmseai fo HVP 6 + 11 atnlg(ie rat.sw) hyTe olko klei bgi owercf.sliaul sihT si in ocsnatrt ot yalCmoodn alat ttah uyo ees ni llspsihyi iwhch is tsuj a tlartef ealtt wborn nkiolog ae.lmuc

  • eianGtl esprHe (eth esanwr to eth enstuiqo) will prestne whit leiptlum nalifup urcasiepfil slsecive ro cuintreolsa hwit ntosiatouctnil sytmomps ev,ef(r as)eimal usJt sfit ebrett nath all het teorh ieoccsh I rna oh.guhtr

  • iihsSlpyl si eth piesnlsa naccr.eh UW edbsecrsi ti sa a ngl,ies udeanidrt llew smcrbcrdcuiie ceul,r iwth a eclna .base See cercosrwk namsorisg no FD rpics.yocmo Kepe in dinm rohte snpiales ceuslr rea manmaryololghpu vmeeeurn of dyaialcm b(tu hte sboeub are tshaw lfpnuai ton the c,eur)l dna aanormlug niieanlug iooonsnvd(sa - keallisebl anstaul)origm tbu athws ramkllha ubaot htsi eon is that sit eslsapin iotutwh emltppnahhyyoda

nI rhtos, eb af.es

drdoom  this write-up is AWESOME ... but it also made me vomit. +
b1ackcoffee  This is awesome, writeup, not the stds. +
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +
homersimpson  Gotta love the BUBOES +
... hungrybox made a comment on nbme21/block1/q#49 (An 80-year-old woman comes to the emergency...)
 +27 
submitted by hungrybox(1108)
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irorazlhydthceiooHd si a thaiizde irtucdei g=t&; adiezhit eudricits era eaiodcasts htwi hplaiaoe.myk

Wtah ehtro rsietuidc rea cesoasdiat tiwh akhly?ipaemo pooL ustcie.rdi

Wh?y

thiIbiinon fo Na+ norrsoibatep rucocs in thbo ploo sudciietr iinibt(h CNCK se)rnotaporrct nda iiethdza ticiedurs itb(nhii ClaN rrornec.pt)rtosa lAl of tshi aesnidcre +Na asercenis dreoltnoAes ti.viyact

vaeRtnle to shti pblo,mer noeAesrtodl peruatsgelu eopenirssx fo het /+aNK+ ATP atoniprrte rbsborea( a+N nito yod,b xpeel K+ tnoi .mlu)ne hisT srlestu in yikplaoemah in hte obyd.

gnaH o,n ehtes'r ermo hhig ieldy fion!

Aeotslrndeo esdo neo rheot tmnrtaopi tghin - ttviainoca fo a H+ lnechna that xlpsee H+ tino the n.emlu

o,S iengv ttah itsh ptnitea ahs oamy,pahleki yuo oknw ehter is iealrgunutpo of osloreetA.nd oD uoy hkint ehr pH wloud be hih,g or w?ol ,ytaxlcE it dowul eb ihgh aubseec ic.n eroeAdntosl g;&t= i.cn +H pledelxe oitn eht luemn &t=g; ltciaebom o.siskala

Nwo uoy drntdensau wyh tobh oplo rtciusedi and dhitizea rticudeis can acsue ws'ath eallcd ayliehm"pock aobitemlc "isksolla.a

hungrybox  jesus this answer was probably too long i'm sorry +9
meningitis  I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks. +15
amirmullick3  This is what NBME should be providing with each question's correct answer! Thanks hungrybox! +1
amirmullick3  @hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."? +1
pg32  Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides? +
cmun777  @madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx +
... usmleuser007 made a comment on nbme21/block1/q#17 (A 7-year-old girl is brought to a clinic in a...)
 +26 
submitted by usmleuser007(418)
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If oyu dltn'ouc bemmrere hwchi erew slneaes;ti tehn anevlaretti ouwdl ehav eebn ot eirzlae atth wigrgon renihdlc deen escll to ded.vii hsTi qesiuerr AND rpenitoialc dan l.ntraations fO cwhih eth cnleuic ciad teymhi si to.mainrpt tI siquerer a leymth estrnafr.

ihsT is rehew eiihtnoenm ecsom ni. iMohtneein ciomesnb wthi PTA ot rmfo SMA (a yheltm onod)r

whossayin  Thatโ€™s a legendary explanation. Thanks dude! +
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2
... acanthosisnegrocans made a comment on nbme21/block2/q#40 (Acetaminophen and nonsteroidal antiinflammatory...)
 +26 
submitted by acanthosisnegrocans(26)
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In eth terga wodrs of rD Sttar:a

da"oansgPltrin 2E staedemi erfeee"eeeeeeve

sASNID t-g&;- oclbk dalagonspinrt nsy

thisisfine   This is all I heard in my head +7
temmy  Me it was so weird +
peridot  I do want to add, that while PGE2 is the right answer, FA19 p.213 says that IL-1 and TNF are involved as well. However, because the question asks about what is going on in the hypothalamus, the answer is PGE2. If the question had been asking about what the macrophages were releasing to influence the hypothalamus, then the answer would have been IL-1 or TNF (FA didn't specify if it was TNF-a though...). +1
feeeeeever  You know why I'm here +7
... sympathetikey made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
 +25 
submitted by sympathetikey(1439)
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โ€ข Pre Poctoorl - yOln ndlicue netptasi in het ssrluet ohw fdlloeow hte roplocto

โ€ข sA atetder - Data swie, nloy arett hte jubsctse sa heyt eerw erattde xe( - if eaetlrxnpiem aepnitt eods thwa hte tnroocl itpntsea rea ssppoude to ,do eomv tath relnexamepti atpntie ot het ltoconr porgu

โ€ข tInionnet ot attre - edlncuI all taeipnts in eth uogprs yteh erew ynrgaliloi zmradnedio ot

... taway made a comment on nbme21/block2/q#14 (A 30-year-old woman comes to the office because she...)
 +24 
submitted by taway(32)
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Tihs qnsuetio si rheapsd ,yenlgrats but si't lyeseslanti gnskai wt"ah wodul anppeh if this 'waonms odyomisrhtypih cbmeea ruoldteocnln vroe eht ourcse fo erh pc"ngnreay?

uleycrntr her SHT is oodg g;t-&- odlecllnowrl-te HhoYmIOyiEhosApiTtry HCdTLP hghi THS ;->- hre dyoripmiotshyh tusm NTO be dcr-elolotwnlel due( to itisduopnr of the 4/H3S/TTRT/HT nireecdon )iaxs

,oS won htat we etudrdsnna that het oqtuesin is gnskai wta"h dluwo phepna if reh ydihotyhpsoimr was rct"uon?lolden

Ase:nrw tsiecrmin

I hktin that thsi oqtsnieu is haesrpd trlcouioy,as but fra be it romf me ot tcrczeiii eht ESULM nngciiels .ao..rdb

yotsubato  I think that this question is phrased atrociously, Just like the rest of the NBME +22
b1ackcoffee  exactly how does maternal hashimoto can cause cretinism? +
notyasupreme  @b1ackcoffee, it's not maternal hashimoto, basically you just have to disregard the ENTIRE question stem and the last part of the sentence (if the mom's TSH goes up) means that there's hypothyroidism going on, which causes cretinism. +3
b1ackcoffee  Thanks you @notyasupreme! +
... henoch280 made a comment on nbme21/block4/q#15 (A 5-year-old boy is brought to the physician for a...)
 +24 
submitted by henoch280(56)
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mm@.yet iTsh eotinsqu stest uor kgdneowle on bimnslai hwcih is rmnaylol a yotiensasr cenfiecyid esesadi but hte ettvineg tsaest htta the o'ysb iblnmasi si csduae by a geietnc mtoatnui in teh T1YRP nege chhwi si hsown in eht amiecbohilc pa.ahywt A eneg ahtt eplhs in eht ssyisehnt fo mnuEiaenl.

wNo you vhae ot saurtedndn atth all pesrsurroc eboefr taht egne is hte pwtyhaa uodwl lilts eb veaaillba fi tno sndercaei iwchh make 2 of the ioontps ni eth nuteqios .owgrn

yuo slao veha ot dendruatsn esmii(lh)E nn:tua = (oralnio)mnmne i.e mlnaor amlenni wcihh si cttrvopeie ot het ,knsi sedcaeser aicvteer goenxy speiecs nda egsiv the dkra meisgntp ot teh i,ris rodcoh,i n,ksi rahi ltc n.oie)en e(.afme.lwih = lemnk)fia(ean ei. maneehnol,pi the one tpnrsee ni rou tnetpia eehr iwchh is sels eiovtecprt naiga hte uv ray,s anncto gnimpet dan tncano eecardes SOR daeeterng ni hte .nisk i oeph siht psleh

... cantaloupe5 made a comment on nbme21/block1/q#3 (An investigator is studying the efficacy of distinct...)
 +23 
submitted by cantaloupe5(81)
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apaluCsr ydoleishccpraa sneicacv rea fento auendgtjco ot ipesornt to rimvoep moiicet.mniygnu lineFglla is hte loyn swrean ichoce 'sthta a i.tnoper

mambaforstep  both MHC 1 and 2 are present antigens that are PROTEINS (FA 2019 pg 100). so in order to elicit a T cell response, you need a protein (CANT BE A POLYSACC). that is why vaccines for polysaccaride antigens are often conjugated to PROTEINs--> so that we can elicit a T-cell response (FA 2019 pg 127). +6
lovebug  Flagellum = Protein, (FA19, pg.124) +
... assoplasty made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +23 
submitted by assoplasty(98)
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asFt rea ngciekteo e(xpcet odd incha )AF, os ethy cerudop koesetn rfo yereng ocuntpdiro teAlc)yo(-AC treahr ahnt culegso. fI the onqutsie skade hwta eht yimrpar usreoc fo enygre ntrdipuoco ,swa it wudol tllsi be oglncgey na(d nto ee,)kntos ebsecau isht si hwitni 42 sohu.r woeeHrv eatrf 24 hruos het warnse ocdul eb toknee .edsiob gRssad,eerl the sqtioeun fcilclpyeisa dais hte pt dha a umsre scolgeu of ,010 dgciiinant ttha we ear lnkogio ofr hsegmotni ahtt ervsopdi a tsebstaur rof eonisceoulsgen.g

rniuDg dosprie fo rttisnvao,a seusattsbr rof oegisnlenscoegu meoc ofmr two c:ersosu 1() abnewdrko fo iinxestg ,culsme or ()2 via cihoad-dn AF huhgort po.-ropoinCAyl aeil(*nV lsao esdfe ntoi olyopirnp A,oC btu si ont onvevidl digrnu nirvatstoa g-;-t& ees ob)ewl

1() ehT aeaauvitprleny-n clcey eopirvsd hits tnal(ugmei ni ulsemc + vrueapty -g;t-& nalniea ;t&g-- esog to ivler t--g;& iiaranmontntsa to utloerheaag-kptoalt -g-&;t apuvryte is aatpeerds rmfo iglneutam ;-&-tg ugaeltimn gose to earu leycc, etvrpauy egso on to igne.scoog)eunlse ctLeata anc asol be seud tis(h uocdl vhea bnee a hgirt aewnsr fi it erew esld.t)i

2)( Odd nahic FsA era losa inguc,olegc tub rtiscae iacd rdidv(poe ni eth swenra ccei)ho tnsโ€™i ddo ,nihac so ti is lyon kneoegcit and acn eb dlure t.uo

gohAlthu elainv (and orteh cbahrdne a..)a edfe noit r-ynoClAPopio, heyt ear ont dsue ni iataovrtns bcaseue aiotasrtnv tsrylitc srieel on iaetphc ueconnegsgil.soe Teehs a.a. era not olzdtmeibea ni hte irevl cusaebe eth elirv lsack dehhncnrabc-ia .aa. raeatefrnss neze.ym In stiFr i,Ad heiBomc stoec,in reudn t/rtgaitsaaSF,noniv in btoh hte snfitgaโ€œ eโ€ttas (chwhi si wtiinh eht iemt mafer of isht soenq,itu) ro eht tsvirโ€œaanto s,etโ€at both liitzue ctaeihp ee.nslciesguoogn My nmtpssioau si ttha nailve is edsu uigdrn egrarul om,tblsmeia dna not gridnu esodpir of v.astnitrao

hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +10
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +5
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1
almondbreeze  @ toxoplasmabartonella think you are right +
... g.liller@yahoo.com made a comment on nbme21/block3/q#5 (A 70-year-old woman is found to have persistent...)
 +23 
submitted by g.liller@yahoo.com(29)
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naaCddi is a prta of the lraomn rofal of ,isnk cludo ecusa mnnitotiaanco of a ntrcela uoesnv hete.rtac heT qtnioesu steast hatt the ngmraios si puepr,l nid,ubdg ddi tno npdreso ot robda sucrtpem tsniiitbaoc aa(k hyte tnidd' eus eofunozclal or imierchaontp ).B ,Ltysla htey edowhs it eldatp no odobl raga and treeh wsa on ihemyslos whhic tinliaesme pahst h(et only hrote bsospile eoedtcnnr rehe).

coopyccuCrst yalsluu lnvovise iigtsinmne in cpmmomeoousrdiinm .stp E. cilo si mgra opsrovinteixg herat si yulauls adtitrsntme by a thnro on a sreo or eeoosmn whit a rihtoys fo gngiredan

hungrybox  Also, the yeast form of Candida is gram (+) +33
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +2
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2
... cantaloupe5 made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +22 
submitted by cantaloupe5(81)
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โ€™Sshe gnakinit 504 msmO epr dya os esh edsne ot eeerxtc 450 msOm pre yad to aimtnnia libu.rmuieiq Yuo anโ€™tc sjtu eecextr โ€™Osmsm yb mteseelshv -- yhte have to be sosvelddi ni msoe amtuon of .aetwr

eโ€™tLs asy oyu terceex 450 msmO iwht 500 mL fo twear -- tath esman oruy sikndey rea acntgicoernnt nreiu to:

045 mOms รท 500 mL = 090 Ls/Omm

Btu eht immaxmu hist aldysโ€™ ynksdie nac ceotatencnr ruine ot si 540 ms,LmO/ os ehs hsa ot eetcxre omer aetrw ot egt it ttah ui.ldet That nomaut of aetwr is 1 L, bceesau 450 ms/1mO L = 504 Lm/Om.s

Now eโ€™tsehr ihnntog oingtpps erh omfr retxiencg eht 540 Ommss in an nvee rome uietld unrie -- orf pxlemea if hse nkdra na xtear L of etrwa neo dy,a eht sikneyd oulcd egt dir of htat retxa L hitw eht msea noamut fo 504 sOmm yb tingilud eth enuri to 045 mmsO รท 2 L = 225 msOmL/. tBu hte ostenqiu ssak rof hte umminim numtao of reawt -- hwchi si 1 L yb eht nkeisdy +( 1 L romf teh htero utffs for a talto of 2 L).

shieldmaiden  Thank God you explained where that liter came from because Flashvoyger just took it out a magic hat and I was completely lost +
skonys  Would be tears be included in the Insensible Water loss? +1
skonys  *my :.( +
... flashvoyger made a comment on nbme21/block4/q#25 (An 80-year-old woman cannot concentrate her urine...)
 +22 
submitted by flashvoyger(22)
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hTe equonits si snagik yuo how umhc weatr usmt eht nmaow eakt in to tiinanam teh aems slmot.olyia ihTs nwoma teask in 504 msOm fo uestol epr ady. ishT is a nuti fo ernmmasteeu -- tikhn of ti elki mra.gs

For hre to pkee the msae asmitloylo she mtus ceeexrt 450 Osmm pre dy.a The ynol yaw orf reh to exeetrc teh eoltsu si avi het ie.ydkns eTh onyl yaw rof her eikdyns ot exrecte 540 mmsO si fi tehy etecrxe 1 ilrte of erwta ls.oa Thsi is teh axm nectonnaricot atht her snkediy anc .rodceup (reH nkiyeds are ton rlwpuefoโ€œ uhongโ€e ot ekam rhe reinu nay remo tedcrtenonac ahtn t.ah)t

ishT onmwa is also solnig narehto tlier fo rawet ot sef,ec ieswangt nda ienariot.spr iTsh si eth snieneislbโ€œ wrtea .slsโ€o atTh maesn fi hse islgon 1 etlir fo aewtr ot ,etswa osrrpiniate dan cfese rep ayd lspu 1 tlier of atrew to eniru (ceebasu hes nsdee to lsvesodi rhe lstueo ni otigne!)shm, rfo erh oodbl to atsy hte sema mltsol,oyai ehs tmsu lreeapc eht wtrea hes tosl tush umts, ta u,imnmmi kindr 2 iltrse fo treaw rpe ayd.

jean_young2019  great explanation๏ผThank you๏ผ +
... pparalpha made a comment on nbme21/block1/q#35 (A 7-year-old boy is brought to the physician by his...)
 +21 
submitted by pparalpha(88)
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eaLd xiiycoTt :

:ueasCs utiprnoids of heem ssistyhne iav bntihiiino fo AAL ia(entillnameouv draa)esydeht

Fignsnid:

A: aAnemi

B: iospaiBhlc slniptigp

C: lcCoi

D: iDarehar

E: lanaothEehpcpy

F: Ftoo ropd

G: umG otpd/rtesshowgi n/etugorrattoiad

H: NTH and ryreacuheipme

trhOe ssearnw:

Zcni eifcindecy:

asC:eus olw akte,ni shn'roC asidees

gdsn:inFi mueimn unic,ndfsoyt daimpier dunow hgialne (for teh lreiomegdn esaph fo duown ,lneihga iczn si edened yb lpsmetnailaoesrote ot kbaer wond tpye III olgel)n,ac oonyiadg,psmh haraei,dr datrem,itsi ceoialp,a lrmnbaoa steta nda lslme

sxEces is ..ear.r tbu cna elda ot n//vd nad oiaamndlb inap

Mnigusmae fydiccenei:

s:sCaeu tnco,alngie rpo,yiaul rintumatoin,l atxivale baues

Fgni:isdn n,aytet reetrampu uintvrrleac coot,nctarni ieadernsc QT aletrinv

1B2 dneeycific:

:euCsas neagv t,edi eosicpiurn i,naeam acieprtacn ss,iuse ratcigs abpyss ry,sruge pmbataolsroin ,ohrnC( )urp,se umoblhliyDhortip artmmeacplwo/ut nioitcnfe

g:diFinsn otamccy,cri ltglciboseaam nae,aim ureon ssyt,opmm snaeerdic ehyoetimcosn dna MAM evelsl in ermsu

csInerdea nitmVai D:

sCa:eus aornulgsmutao eessadi acidsi(s)orso

nsdigniF: oben o,poentrirs oot chmu ,cmaclui sslo fo t,eeatppi psoutr

lovebug  2019 FA, pg 411. +
lovebug  Nephrotoxicity results from lead exposure because the kidney is the main route by which lead is eliminated. Lead is absorbed by the proximal tubular cells of the renal tubules, where it binds to specific lead-binding proteins. +2
... hungrybox made a comment on nbme21/block3/q#20 (A 68-year-old woman has had a fever and shortness of...)
 +21 
submitted by hungrybox(1108)
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mseo wnogr assern:w

*akmse snees cb/ asmblsteyol era rprossercu ot sycn,geltouar hiwch esu MOP ot tgifh ffo iocfinnets

temmy  Hungrybox aka life saver +1
hello  Thank you!!! +1
bbr  ....uh yeah im pretty sure we just call em "Auer Rods" now. Appreciate the answer tho! +7
... drdoom made a comment on nbme21/block3/q#21 (A screening program is instituted for detection of...)
 +21 
submitted by drdoom(957)
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0,250 stdtnuse ... tbu oyu ndfi tou dgrinu oyur alitnii scrnee ttah 005 adlyera eahv hte eesadis. S,o tesouirkt teohs le.eopp haTt evseal 2,000 enstdtus owh ntodโ€™ vhea the eed.sasi

rveO eht rsoceu fo 1 ye,ra uoy vcesoird 002 enuttdss doelvepde eth .nitcoinef sT:hu

020 wen ssaec / 0,020 eoplep hwo dโ€™nitd vaeh hte iesdeas nhwe ouy arsttde uyro dusyt = 01 pncerte

ir,Tkyc krtciy EMBN ...

sympathetikey  Ah, I see. Thank you! +
niboonsh  Im mad at how simple this question actually is +7
sahusema  Incidence is measured from those AT RISK. People with the disease are not considered to be at risk. So 2500 - 500 = 2000 people at-risk. Of those 2000, within one year 200 develop the disease. So 200/2000 of the at-risk population develop the disease. 20/2000 = 10% = incidence +3
daddyusmle  fuck im retarded +2
skonys  Must be Florida State University.... +
... usmleuser007 made a comment on nbme21/block4/q#43 (A 4-year-old boy falls and lacerates his lower leg...)
 +21 
submitted by usmleuser007(418)
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  1. aisHbsmtd(seoย loo )olttgc:in ntiiWh eht srfit ewf iemsnut of nijy,ur
    1. pleintsltaย e eth bdool eginb ot kscti to teh jurdnei ist.e
    2. hTsi aaeivttsc the llse,tptea ncuaisg a wef shnigt ot p.aphen
    3. hyeT ceangh itno na apurohosm seha,p emor tiealubs fro igonltc,t dna yhet sreleae caimhlec nlsgsia to tpmrooe cgnittlo.
    4. sihT sutsler in the vaaoiittcn fri,ย nobif hciwh rsmof a eshm dna tasc as lgue"" ot bnid seltletpa ot ehca .rhoet
    5. shTi easmk lhย taatcoย t esvsre to gulp eth reakb in teh lbdoo eelvss, /inepngsiewnlvotrg hufrert 5.d[gib]ln6[e]e

  2. Inionmmalt:af uirnDg tshi seha,p maegadd dan aded llces era eldrace uot, goanl ihwt erbaiact nda rehot oatnpgseh or bsr.die
    1. sihT shpeanp hutorgh teh ecorpss t,hssifpoagcoyoย  heerw ewhit lbdoo elscl et"a" breisd by ugnlgeifn tiย .
    2. ateldPdereveitl- trhgwo aย ftaocrser easrldee noti the uwond ahtt cesau eth aognirtim nda iisndvio fo slecl dnigur the opiireflatrve sehp.a

  3. tafeiorrPlion gthro(w of enw :esuist) In sith dslurineiioย ngonย lsaiae,nsspoย tennaaacย ggeptohigl,e,o ooits,naftemuย sri iezioneiltai,apthl nda odwun oinranoctct cur.co
    1. In eognaisnis,eg arsvucla ediealhtonl lsecl mrof new lodob lvssees.
    2. In aobfiipalsr and gaatnrnioul iutsse orfwrlimantoย tibroย sofasgb, dan mrof a ne,w crpvaulxsoliialeraย onltre rย (xEt)mCMia yb trxeinegc canlgole ocย neintfb.inard
    3. clntroCnru,ye eieilpnrlaiht-toaiez of eth rmseepidi crs,uoc in chiptiย lwiheaehl aleolfresrย tcelpi dna 'rlc'aw poat het nwduo ,edb pdivognri cvoer ofr hte nwe eut.ssi
    4. In unwod loresr,onceย smeiย iancyartobttoabdcfs hte isze fo teh wundo yb pgigripn eth odunw egeds dan cigatncnotr giuns a seanimchm htta bmseesrel tath ni ohosmt smcuel slelc.
    5. nWeh eth sllce' esrlo aer oelsc to compt,eel dundenee lescl pupย sros.ieaotgndo
  4. touantMair i:len)me(gdro giunDr ttmanuaior and oilee,gmndr

    1. ecloagln is alenrgied gloan tninose ln,sie dna sclle thta ear no gnroel neddee era mdrveeo yb pemrmgdora ellc dteah, oiย rsoos.patp

  5. pxtparAmieo tsmie of eth iftfrdnee espsha of wnodu [nethl01ih],igwย a efdda atlirsvne gnirmak bnltaisstua rt,vaiaion gndedipne imnlay no nodwu eisz nad ingehla nnio,tcdiso utb gmiea dose otn iuncled oarjm isinmtapmre ahtt hcย crncoseaiu ndsow.u
mumenrider4ever  Great explanation! FA 2020 pg. 216 describes the phases of wound healing +
... hungrybox made a comment on nbme21/block3/q#3 (A 55-year-old African American man with hypertension...)
 +20 
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Teh 2 momadntmscen fo tscieh otsiequ:ns

  1. ot'nD reev pick na nsrwea rehwe uyo unsod ielk a cdki
  2. 'tonD vere ustconl teh ecthsi tmieemtco

rvdeSe me llwe on isth eotquns.i

linwanrun1357  If there is a choice about asking what the patient is worried about. Is this right? It does not sound like a dick :) +3
champagnesupernova3  If this were about a treatment asking why hes worried would be right but hes kind of doing the hospital a favor so I dont think you're supposed to try to convince or pressure him +1
brasel  also, any patient participating in any research study can withdraw whenever they want. Answer E is wrong because he shouldn't have to go through hoops to quit, he can just drop out at any time. +1
... mcl made a comment on nbme21/block2/q#30 (A 44-year-old man comes to the physician because of...)
 +19 
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Tish si a rytpet dgoo rfguie nsiwohg hte svneocrnoi of nrbeeamm hhoidplpssipo to iniachcodra deei/toikenuarlcs c.te

cBdkaelo fo CXO nymzee by ibpnouefr sertuls in acseredde coitrnpuod fo taniprssgloand 2H dna E,2 ihwle asnguic eth orpcsuresr to kc"ab p"u d(earicnse daocaniihrc adc.i) hT,si in ru,tn stursel ni rneidcaes ocnrtidoup fo i.euntreolske

icedcoffeeislyfe  FA2020 pg 485 has a figure that is helpful! +4
... imgdoc made a comment on nbme21/block2/q#33 (A 68-year-old man comes to the physician because of...)
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I thughot touba it elki th:is ttePina is vanhgi sphioygecnc ED - ist lal in ish deh,a iibold is nolarm nda ncrolunat rniosecte rae rnao.lm

fI ish teeosTtesron leevl swa lwo - iLoidb sdecaedre. fI shi serunov yemsts ap)/miipptratscha(haetecsmyty wsa agemadd - ulnonrtac rnsitceoe sdeaceder.

pHeo isht ph.esl

sars  Idk about this. My thoughts: -libido is a product of testosterone and emotions (psychogenic) -tumescence is a product of pelvic splanchnics S2-S4 (parasympathetic) -patient's issues are 1 month old (aka recent) and his wife died 2 years ago & testosterone is normal (therefore libido normal) -patient can jack off, therefore penile stimulation reflex arc is intact and pelvic splanchnics are working (nocturnal tumescence normal) +2
... hayayah made a comment on nbme21/block2/q#50 (A 65-year-old woman comes to the emergency...)
 +19 
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trhtCeae pnca:eemlt

kesna41p0cn-mtn..g00ewoeldou/amj6p/pse/y//2:geitp8tcs0o/08/ath

aellcR atth het glun eaxp txsnede vbaoe het frist rbi.

hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +30
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +12
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +5
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +
... beeip made a comment on nbme21/block3/q#4 (A clinical trial is conducted to compare the...)
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I ghmti eb the loyn prneos on atehr who got shit neo ,wnorg utb sldrs:eerga

T"IT asiylsna sueinlcd ryeev tusjcbe who is zdearoindm giccronad ot rdaizonmed tnaemtter gst.iansemn tI roigsen npeoocn,ilmacn octorlop ans,ieodvit hawtdliaw,r dan antnygih ahtt pahespn etraf oamdi.z"roantni[]1

yo  You're not. I also goofed. +20
seagull  https://www.youtube.com/watch?v=Kps3VzbykFQ This video is a pretty decent explination worth your time on the subject. +2
hungrybox  I got it right but I was only like 50% sure. So I appreciate it. +
teepot123  ^ same video above used when I analysed my form 20 q which I got incorrect at time, its very clear at explaining this, helping me get it correct on this form +
... cellgamesgojan made a comment on nbme21/block3/q#35 (A 63-year-old woman comes to the physician because...)
 +19 
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VA sialsutF rru-toe odbol fmor teh aalertri syemts ot hte onvuse seys,mt sa-npsyibg eht roilsetreA = Isnceare PL gt-;-&- SNICAREE .RV All ni all = eIecsarn OC.

gcdconAir ot UoWld,r eht ortilserae rea a mjroa escuro of erscsietna ... os iapbgysns teh seliortrea leutrss ni a creedesa in aloTt rhPiaeplre tenassRcei ... scuniag an iesncare ni eth erat nda vleumo of oblod urnegtnir to eht teh.ra I am rptyte ruse etehr is rmoe ot eth oyplyisgoh ehbind stih, btu I ohpe hsit aepdelnix a itl.tle

big92  "Immediately following creation, arteriovenous fistula (AVF) is associated with an increase in cardiac output (CO), achieved predominantly through a reduction in systemic vascular resistance, increased myocardial contractility, and an increase in stroke volume (SV) and heart rate. Over the following week, circulating blood volume increases in conjunction with increases in atrial and brain natriuretic peptides. These alterations are associated with early increases in left ventricular (LV) filling pressure with the potential for resultant impact on atrial and ventricular chamber dimensions and function." (PMID: 25258554) There's also another study by Epstein from the 1950s looking at the effects of AVF's effect on CO in men (PMID: 13052718). Apparently, the increase in resting CO is a big problem because it can lead to high-output cardiac failure (LVH). +31
hungrybox  Jesus big92 you went in on the research lmao u must be MSTP +6
temmy  big92 you are right. that is why pagets disease pagets have high output cardiac failure because of the av shunts. +4
kevin  what is "increase PL" +3
jhan17  According to wiki "When an arteriovenous fistula is formed involving a major artery like the abdominal aorta, it can lead to a large decrease in peripheral resistance because it by pass arteriole (where major BP is formed) . This lowered peripheral resistance causes the heart to increase resting cardiac output to maintain proper blood flow to all tissues." +
... beeip made a comment on nbme21/block4/q#6 (A 55-year-old man comes to the physician because of...)
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sihT sah eben a gtuho etcnpoc ofr em ot ge,t tbu I hkint 'mI lilnayf ehtre:

The mtse si gcbsiridne yprmira aeadrnl isyufecif,cnin ro sAdno.di's

  • HATC is giben ceudporv-droe ot lmtietasu eht leaarnsd ot couerdp ooisrc,lt tub ehyt cat'n o,pesrdn eterih ued to ahrytop or rtcidouenst B,T( moau:itmune ,DR4 tce.)
  • eTh ftsir 13 nimoa dcais of ATHC nac be edvcael to fmro ,ฮฑM-SH chhiw mssiuttlae mensel,coyat gcniuas tneohaymnippgitre
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +10
hungrybox  thank u for this answer +
bilzcop  Ugh! I misread the question and chose ACTH :( +3
cienfuegos  @bilzcop: same +
cienfuegos  @bilzcop: let's never do it again, k? +1
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +2
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +
... hungrybox made a comment on nbme21/block4/q#20 (A 7-month-old boy is brought to the physician 2 days...)
 +19 
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ihsT oived ipnexlas tignela remoylyogb retxlmyee wle.l

If oyu tlef ttolaly tosl elki me, tchaw teh veodi itfsr ta ,x2 then cchek out eth ttombo ufgire no pg. 608 ni AF .0129

Rnleaetv ot shti :qosenitu

  1. SYR sertinpo suetmtali loneeedmvtp fo estest
  2. isTh pt ahs tsetse =gt&; he muts heav eht YRS neeg no het Y ocomeomrhs
  3. FIM dsdgaree hte alrnuielM cutd, hicwh lduow eorshwtei mocebe hte anenltir aelfme gnaaiilet
  4. ishT pt ahs lntiaren eefmal neatigali g&t=; 'dndti amek oeugnh IMF

zuiQ eyloufrs ssnwe(ra ni a peaeatsr )os:pt

  1. Tsih etisatnp' dsoreird cna be rctaed bakc to whchi cl?esl
  2. shiT eapintt hda aornml iia.lengat fI hits anpiett dha mlrlase tniigaeal hnat aln,omr htat owuld be a cfdtee in ahtw mn?zeey
ergogenic22  I like to work backwards. 1) patient has normal testicles on histology, normal appearing penis this must mean a Y chromosome is present, as testis determining factor is on the y chromosome (see above post point #2). I.e. you can eliminate choice A and B. Theoretically, 47XY and 47XYY could also present with female genitalia due to lack of MIF, but normal 46XY is more common +12
... seagull made a comment on nbme21/block4/q#40 (A study is conducted to assess the normal mean serum...)
 +19 
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niEmxinga nttaepi ormf a ootilsrug smeiilp noersBk Bais wchih oldwu ekws the ouatlponpi nmea fo rsmue eaur gterionn yaaw rfmo teh ruet ceacurat ae.nm ehT,n aeilerz erpnsciio is neddptene no attliaiscts Pr""weo hhwci si isaneecrd sdabe on teh szie of het pialonuotp of eth ds.tyu reidsanc(e osienpcir = rinseadec saititltcas we)po.r eeoTrfe,rh na ranisece ni oipuntaolp of a bedsai pogur twih deal ot cinycuacra itwh high epi.sinorc

forerofore  to add up, the urologist himself doesn't add or remove accuracy (since this is a blood test), what decreases the accuracy is the fact that in order to be sent to a urologist you probably are sick in the first place (selection bias), so your urea nitrogen is likely to be altered. +24
sharpscontainer  I thought of precision as more of a function of variance. Variance will decrease with a greater sample size. Had a hard time because I was thinking about those 4 darn targets (wouldn't 500 darts look more spread out than 10? but no, the variance will be better) that have been in my textbooks since 7th grade and for the first time I was asked a question about this concept only to discover that I didn't have it down as well as I assumed. +1
peridot  @sharpscontainer I feel you, I thought the exact same thing. Looked into it a bit and I think it has something to do with the way standard error or standard deviation or something like that is calculated, but I'm still confused and too tired to dig further. Also, wanted to mention that this NBME has a similar question but instead it's about the 95% confidence interval - maybe that'll help you understand the precision thing better since the 95% confidence interval narrows with a larger sample size? So it's kinda tied to precision? +
... drmantistoboggan4 made a comment on nbme21/block1/q#47 (A 26-year-old woman (III-2) comes to the physician...)
 +18 
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It dasi it aws atafl to smael ni truoe, adn het tieunosq eadsk tubao vlei rbon noff.isrpg Secin the lsema rantโ€™e biegn robn in eth iftrs plac,e I dsia 50% eemlsfa nda %0 meas.l

hungrybox  fuck i got baited +32
jcrll  "live-born offspring" โ† baited +26
sympathetikey  Same :/ +
arkmoses  smh +
niboonsh  why is it 50% females tho? +2
imgdoc  felt like an idiot after i figured out why i got this wrong. +2
temmy  oh shit! +
suckitnbme  This isn't exactly right as males can still be born as evidenced by individuals III 6,9,11. This basically an x-linked recessive disease. A carrier mother can still pass her normal X chromosome to a son (50% chance). It's just that the other 50% chance of passing an affected X chromosome results in death of the fetus in utero. Thus all males actually born will not be affected. +3
makinallkindzofgainz  @suckitnbme, Correct, but if you're a live-born male, you 100% for sure do NOT have the disease, so the chance of a live-born male "being affected" is 0. +3
spow  @suckitnbme it's not X-linked recessive, otherwise every single son would be affected and therefore have died in utero. It's X-linked dominant +3
qball  Jail-baited +
srmtn  correct @spow affected females= X linked Dominant +
... hayayah made a comment on nbme21/block2/q#29 (A healthy 25-year-old man is participating in a...)
 +18 
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.P 19 fo FA has a qciuk lxtenapoian rof hts!i

lycaasliB oecn yrue'o ni a tnrgsiav attse ter'esh sltli piahetc ugsonseigeneclo gogni on (as lelw as suing )FAF but the egcesoonuleisng si gomcni mofr ailrpeeprh esuist taetalc dna .nenaial

... feronie made a comment on nbme21/block3/q#7 (A 65-year-old man comes to the physician because of...)
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omtyciOcreh = โ†“ ntoetsotseer noutrciopd = โ†“ DTH &=gt; eatporst clsel dgnuoer ptips.soao (Tshi hemnscima is riialms ot ugisn d5teฮฑ-aercus koersblc to ttrea PH)B.

pposAtsio si aaitcrcdheerz yb NDA nafatrogimnet kso(ynsp,i oxr,raihrysek .ay)lyssorki

hungrybox  DNA fragmentation histopath: https://i.imgur.com/nxYW8vL.png Note that degradation in apoptosis is progressive. From pyknosis -> karyorrhexis -> karyolysis. Aka condensation -> fragmentation -> complete dissolution. +27
... hayayah made a comment on nbme21/block3/q#27 (A 55-year-old woman with a benign nodule in the left...)
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eTh yrhitdo is pudlepis ihtw arraeitl oodlb mfro eht erpsouri htdriyo etayr,r a brnhac of the tlaenexr oirtdac reryta, dan eht rnifiero oihtydr ry,reat a arnbch fo hte ctclvayoriehr tkrun.

... hayayah made a comment on nbme21/block4/q#23 (An investigator is studying the regulation of...)
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phLmy owfl etar is sylaulu .wol It is ednleucnif ripaliymr yb hte trae fo myplh mtoofrn.ia roF xepeal,m if bdloo yracaplil ssreuerp is aieescnrd by irtarela dnaoasotvili ro evnous otrtsci,innco eth fowl trea fo lyphm rnac.issee o,Als teh lofw eart si aefdtcfe yb mriscepnsoo fo catsphilmy yb naoiocttrnc of gioebrninhg tsrumuuaecl nda by gevnieta aaitcorhicrnt erspreus (th.be)airgn

ltintsrItiea erreupss s(o sepuresr ni eth EF,C chhwi uowld seacrien fi inveg VI niasl)e nad ymlhp folw rea yiisolvtep d.erleat A samll aneciesr ni ietliiasntrt voleum regylta cnassieer sti u,rserpse gmonotrpi plhym lfow ahtt acst ot rrotese eth arttniisietl ulemov to onmalr.

roem on htsi ipto:c opKvwitwh.g/lm.:3/4o.B8tbi5s//bh4kno/Nnwcns.

linwanrun1357  Do not understand the breathing ๏ผˆchoice C and D๏ผ‰ breath in and out are different? +
khanhluong  I don't know if it's correct or not but how I approached C & D was that they both cause vasoconstriction in the arterioles (because this is the lung where hypoxia causes vasoconstriction), which decreases hydrostatic pressure through the capillaries and eventually decreases lymph flow. Maybe I completely got this question right for wrong reason, but I felt that it works with all of the answers. For F) I was thinking that it would cause increased capillary oncotic pressure which causes more fluid to go into the capillary than into the lymph vessels... Here's a picture: http://www.lymphedemablog.com/wp-content/uploads/2011/09/Lymphatics.gif +5
... step1soon made a comment on nbme21/block1/q#16 (A 43-year-old man comes to the physician for a...)
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esagitu/ya:itlkd/tepaomcys.//har-drovlh-lvaoerse

koLo ta eherw eth csspu are gipionnt โ†’ pwrdsau orfeherte aio.trc if usscp rewe wdrwnoda โ†’ ehtn lrtaim vvlea dowlu eb the ihgtr nsrwae

misterdoctor69  mitral valve would only have 2 cusps even if it were replaced though right?... +
bbr  After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +3
... hayayah made a comment on nbme21/block1/q#22 (A 36-year-old man with AIDS elects to participate in...)
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eeCeicnyesits-tyn chmoeiekn cropeetr 5 (C5C)R si a rnetopi dfuon on hte cuasfre fo DC4 scle.l

yotsubato  Note, this is NOT in FA +2
sbryant6  It is in UWorld. +3
almondbreeze  it's in FA2019 pg.110 +1
almondbreeze  but missing the full name for CCR5 +4
demihesmisome  CXCR4 is also a chemokine receptor. +2
sononono  Uworld ID 953 +2
... yotsubato made a comment on nbme21/block2/q#18 (A 34-year-old woman comes to the physician because...)
 +17 
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lelW sttah a yralle urecd wya to ncseer rfo .e.osnedsirp.

champagnesupernova3  There's really no other way to say it without using euphemisms +4
drdoom  You canโ€™t rule out suicidal thoughts via inference. +
drdoom  LAWYER: Did you ask the patient if she was suicidal? DOCTOR: Well, um, no, not exactly โ€” but, I mean, she seemed okay .. +
drdoom  LAWYER: So, a patient walks into your office, you suspect post partum depression โ€” a diagnosis with known suicide risk โ€” and you didn't ask if she was suicidal? +
drdoom  DOCTOR: gulp +
beetbox  @drdoom wow ok now this will stick to me forever. Always ask your patient so I can avoid lawsuits! +1
... ergogenic22 made a comment on nbme21/block1/q#6 (A normal-appearing 17-year-old girl has never had a...)
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roanmchti eevtniag = on rarb sbioed = osrnpe tiwh XY noygeetp ro XO eesbcua aynmeit you haev rmeo anth one X emomrcoohs ouy ehva a brra dyob ahno(mticr eipto)vis

... hayayah made a comment on nbme21/block1/q#11 (A 27-year-old primigravid woman at 34 weeks'...)
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LEHLP rnoyedms: EedHslyev smteoila evLri oe zmLsenyw e.Ptslleat

A nnosmiittaaef of esreev apaerimc.psle Bdolo mersa shosw os.cctitseyhs Can eadl ot ICD dan caiehpt elahcamotsuupsaab msr ยŽ tupurer ยŽ seerve .hpiesnynoto

mambaforstep  FA 2019 pg 629 +4
qball  One thing I find odd with this question is HELLP is a manifestation of severe preeclampsia but she has had an otherwise unremarkable pregnancy. Shouldn't she have hypertension/edema in regards to her pregnancy beforehand? +
demihesmisome  Pre-eclampsia, if not severe, can be entirely asymptomatic. +1
misterdoctor69  Her blood pressure is 164/102, which qualifies her as having preeclampsia. +
... nicnac20 made a comment on nbme21/block1/q#28 (A 47-year-old man is brought to the emergency...)
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submitted by nicnac20(18)
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idxMe vnsuoe yngoex sennito is teh noamut of xongey noubd ot oolmgheinb sa ti nrreuts to teh gihrt dies of het etrha eafrt lirtneagv ot the eistus.s

aedreceDs yongxe edlviery ot hte utsises ude ot asdreceed daaccir ottpuu dlsea to hte ustsise etanitcrgx ermo onxegy omfr eht ansipsg BRCs athn ehty ylnolmra oudl,w hhciw sceasedre the lraovle ixdem soenvu oxnyeg e.oisntn

pparalpha  A helpful equation is CO=rate of O2 consumption/(arterial O2 content-venous O2 content): Fick principle If CO is decreased, then the difference between arterial O2 content and venous O2 content is increased +16
misterdoctor69  To clarify a little bit, the tissues wouldn't necessarily extract MORE oxygen from the passing RBCs than they normally would. They would extract the same amount as they normally would to carry out their own functions. However, because the starting amount of O2 delivered to tissues is lower, you'd end up with less O2 bound to hemoglobin returning to the right heart. +5
... neonem made a comment on nbme21/block1/q#43 (A 52-year-old man is brought to the emergency...)
 +16 
submitted by neonem(578)
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eprMonhi is a um opiodi aotsnig - eon serdvea cffeet fo doiipso si mast cell neraaolngiudt tath is n-IegepidndEnet. eaRlees fo mthniieas is kina to na tcnaiylacpha oncaeitr t;g&-- t,uisrrpi ce.t

sympathetikey  Never had heard of that one. Just a good guess. Thanks! +
yb_26  IgE-independent mast cell degranulation can also be caused by radiocontrast agents, some antibiotics (vancomycin) +7
temmy  it was a u world question +
mambaforstep  FA 2019 pg 400 +
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +
mannywillsee  i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +1
mambaforstep  under mast cells "IgE-independent mast cell degran"! FA 2019 pg 400 +
mumenrider4ever  Uworld QID 11852 talks about this Also FA 2020 pg. 408 (under mast cells) +